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Identification of acute and chronic renal failure is very important
Renal failure is a common clinical disease, acute and chronic. Acute renal failure (ARF) can be cured or alleviated if it can be diagnosed accurately. So it is important to distinguish between acute and chronic renal failure, the following is the differential diagnosis of acute and chronic renal failure:
Acute and chronic renal failure (CRF) is a distinguished clinical diagnosis, according to medical history, other indicators; two is the pathological diagnosis, pathological diagnosis of renal biopsy is the gold standard for the identification of ARF and CRF, but the domestic emergency conditions of the hospital have renal biopsy is still not widely. Therefore, it is of great importance to select and evaluate noninvasive markers to identify ARF and CRF clinically.
We analyzed the clinical data of 100 patients with renal failure in our department, including the pathological diagnosis of renal biopsy in 82 cases:
(1) the length of the disease is the basis of distinguishing acute and chronic renal failure. Half of the CRF50 cases were less than 1 years of age, of which one of the three patients with acute disease, less than 3 months of illness. Therefore, the length of illness as a basis for judgment, especially CRF is not reliable. The literature and the data of our department show that the proportion of the change of diagnosis is higher after renal biopsy.
(2) at present, China has been widely used "B" super measure the size of the kidney. It is generally believed that the enlargement of renal volume is seen in ARF. Our data suggest that both acute or chronic renal failure, kidney really increase or decrease only accounted for 1/3, the majority of cases of normal renal size, this part of the people using the ultrasonic kidney size no help in acute and chronic renal failure identification. Recently, we found that "B" measurement of renal parenchyma thickness was more significant than that of renal volume measurement.
(3) the determination of nail creatinine is a noninvasive and simple method, which can reflect the level of serum creatinine before three months. For patients with occult onset or unknown history, the normal size of the kidney, nail creatinine can be understood 3 months ago, renal function, the specificity of up to 84%, can be used as a supplement to the above two data.
(4) anemia is one of the clinical manifestations of CRF, has been loaded into the textbook, as one of the identification points of ARF and CRF, there was no significant difference in the detection rate and severity of anemia in patients with ARF and CRF in our department in the analysis of 100 cases. In the past we have reported 20 cases of acute nephritis, half of them have anemia.
In addition, hemolytic uremic syndrome caused by ARF can appear severe anemia, acute expansion of ARF can cause mild to moderate anemia. Acute interstitial nephritis due to acute nephritis due to decreased production of erythropoietin can also be manifested as anemia. Therefore, we believe that anemia as an indicator to distinguish between ARF and CRF is not reliable.
(5) the increase of nocturia and the decrease of urine specific gravity were the clinical manifestations of CRF. Half of the ARF cases in our department were lower than 1.015 in urine, and there was a significant tubulointerstitial lesion in renal biopsy. This phenomenon could explain the decrease of ARF in urine.
(6) urinary cytology and other visible components should not be ignored in clinical diagnosis. Urinary sediment in total, renal tubular cell necrosis cell number, number and type of tube type, is suggestive of renal tubular necrosis; the number of the more serious illness, worse renal function; acute interstitial nephritis acute renal failure occurred in urinary sediment eosinophils; urine in large number of red blood cells, especially red cell casts prompt glomerulonephritis caused by acute renal failure.
(7) in ARF, especially in acute tubular necrosis, the increase of urinary enzyme, brush border antigen and urinary adenosine binding protein is also helpful for differential diagnosis. (8) our data failed to show how the serum calcium and phosphorus concentrations were helpful in the identification of ARF and CRF.
Through the introduction of the understanding of acute and chronic renal failure, so experts remind patients to seize the right time to treat renal failure on your body has a multiplier effect.
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